ACOG Committee Opinion: Emergent Rx for Acute-Onset, Severe
In a recently released document, the American College of Obstetricians and Gynecologists (ACOG) provides an ‘interim update’ regarding the emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. The present committee opinion replaces the one released in 2017.

“Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy.”, the authors write in the document.

The guidance document mentions that the goal should not be to normalize BP instead it should be to achieve a range of 140–150/90–100 mm Hg in order to prevent repeated, prolonged exposure to severe systolic hypertension, with subsequent loss of cerebral vasculature autoregulation. In the event of a hypertensive crisis, with prolonged uncontrolled hypertension, maternal stabilization should occur before delivery, even in urgent circumstances.

Following are the recommendations and conclusions:-

• Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy

• Close maternal and fetal monitoring by a physician and nursing staff are advised during the treatment of acute-onset, severe hypertension

• After initial stabilization, the team should monitor blood pressure closely and institute maintenance therapy as needed

• Intravenous (IV) labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period

• Immediate release oral nifedipine also may be considered as a first-line therapy, particularly when IV access is not available

• The use of IV labetalol, IV hydralazine, or immediate release oral nifedipine for the treatment of acute-onset, severe hypertension for pregnant or postpartum patients does not require cardiac monitoring

• In the rare circumstance that IV bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal–fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended

• Magnesium sulfate is not recommended as an antihypertensive agent, but magnesium sulfate remains the drug of choice for seizure prophylaxis for women with acute-onset severe hypertension during pregnancy and the postpartum period

• Starting magnesium should not be delayed in the setting of acute severe hypertension; it is recommended regardless of whether the patient has gestational hypertension with severe features, preeclampsia with severe features, or eclampsia

About ACOG
Founded in 1951, the American College of Obstetricians and Gynecologists is the speciality's premier professional membership organization dedicated to the improvement of women’s health. With more than 58,000 members, the College produces practice guidelines and other educational material.

Note: This list is a brief compilation of some of the key recommendations included in the guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Emergent-Therapy-for-Acute-Onset-Severe-Hypertension-During-Pregnancy-and-the-Postpartum-Period
Dr. S●●●●●v K●●●●●i and 2 other likes this3 shares
Like
Comment
Share